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General NPI Number Information
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NPI Number | 1184013427
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Entity Type | Individual
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Provider Name | ELIZABETH VAIL ROBERTS PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 69 CHURCH ST STE 4
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City | LENOX
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State | MA
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Zip | 01240-2540
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Country | US
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Telephone | 413-274-2393
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Fax | 413-353-5006
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | WEST STOCKBRIDGE
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State | MA
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Zip | 01266-0306
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Country | US
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Telephone | 413-274-2393
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Fax | 413-353-5006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 012490
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License Number State | NY
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